The choice of pericardium type used for reconstruction is crucial for morbidity following the Norwood I procedure

Objectives: Since June 2003, 18 Norwood I procedures have been performed using the standard augmentation of the aortic arch with heterologous pericardium. The increasing rate of restenosis after the first 5 procedures in mainly the coarctation area alarmed the surgeon and the decision was made to switch to a different heterologous pericardium with successful results.

Material and Methods: All patients were operated in the standard way using heterologous pericardium to enlarge the aortic arch. The first 7 patients received equine heterologous pericardium, and in the last 11 patients bovine pericardium was used. No other change in surgical technique or suture material was done.

Results: The group reconstructed with equine heterologous pericardium showed restenosis in all 7 cases (100%). Stenosis was located in the coarctation area requiring balloon intervention (5) and subsequent reoperation (3), in the aortic arch requiring reoperation (1), and in the pulmonary region with the need for balloon dilation. The second group with bovine pericardium showed restenosis in 3 out of 11 cases (27%). Those could be treated with balloon dilation only. The difference in restenosis between equine and bovine pericardium was statistically significant (p=0.007).

Conclusions: The change from equine to bovine heterologous pericardium improved the freedom of reintervention and reoperation. The thicker aspect of equine pericardium and the tendency to shrink may explain for the difference in outcome. On the basis of this preliminary results we recommend the usage of bovine heterlogous pericardium for aortic arch reconstruction in the Norwood I procedure.